Meaning in Life: A Novel Factor for Promoting Wellbeing in COPD

Introduction: Research evidence indicates that meaning in life (MIL) is a meaningful outcome in individuals living with chronic illness, but evidence is lacking for chronic obstructive pulmonary disease (COPD).

Objectives: We hypothesized that MIL is independently associated with clinically meaningful outcomes for patients with COPD.

Methods: We performed cross-sectional analysis from a large cohort with moderate-severe COPD that participated in a home pulmonary rehabilitation study. MIL was measured using the Meaning in Life Questionnaire (MLQ), with domains of Presence and Search. The study included 340 participants: mean age 69 years old (standard deviation [SD] 9.4), 55.3% female, forced expiratory volume in 1 second (FEV₁) 44.3% (SD 19.4), and a modified Medical Research Council (mMRC) dyspnea scale of 2.69 (SD 0.84).

Results: Patients with high MLQ Presence (versus low score) had meaningfully better scores (beyond the minimal clinically important difference) across all Chronic Respiratory Questionnaire (CRQ) domains: Dyspnea, Fatigue, Emotions, and Mastery (p≤0.02); self-management (p≤0.001); social support (p≤0.001); anxiety (p≤0.001); and depression (p≤0.01) scores. When adjusting for age, sex, FEV₁, mMRC, social support, and anxiety, MLQ Presence was independently associated with CRQ domains Fatigue, Emotions, and self-management (p≤0.01). MLQ Search was independently associated with CRQ Dyspnea, Fatigue, and Mastery (p<0.05).

Conclusions: In patients with COPD, the perception that life has meaning or the willingness to search for MIL is associated with the outcomes that patients consider most important. Our results are novel as MIL is a potentially modifiable outcome that could complement person-centered conversations during clinical visits, pulmonary rehabilitation, and health coaching.